Creative solution by doctors prevented open abdominal surgery

Surgeons are frequently called on to find creative solutions. In the case of S., a woman in her late 40s, who came into Hillel Yaffe Medical Center suffering from cholecystitis - an urgent and creative surgical procedure was unavoidable.

Upon admission, S. underwent a series of imaging tests, which led the doctors to suspect biliary stricture - which could indicate a tumor or other potentially life-threatening finding. “To diagnose and treat biliary stricture, the standard test is ERCP. It combines an image obtained using an endoscope (a flexible device inserted through the mouth into the duodenum and reaching the opening of the bile duct and the pancreas) and x-rays. In this case, the test could not be performed, because the patient had previously undergone bariatric surgery (gastric bypass) for weight loss, which changed her anatomic structure,” said Dr. David Aranovich, Director of HYMC’s Liver and Bile Duct Surgery Unit.

Doctors from the Surgery Division and the Gastroenterology Institute at Hillel Yaffe performing the procedure

The experts at Hillel Yaffe had no choice but to find a creative solution to diagnose the source of the stricture. In consultation with a multidisciplinary team, which included surgeons and gastroenterologists, this type of solution was found. “Using an innovative technique with a fiber optic device, we were able to take a sample through a minimally invasive - laparoscopic approach, without having to open the abdomen. Use of this device presented us with a high-quality image that made it possible for us to look into the bile ducts while performing surgery to remove the gall bladder. Had we not used this rare technique, we would have had no choice but to perform surgery through an open approach, which would have required a large abdominal incision. That is a longer and more complex surgical procedure, which could have put the patient at significant risk,” said Dr. Viacheslav Zilbermintz, Director of Advanced Laparoscopic Surgery at Hillel Yaffe.

The rare procedure was performed at HYMC by the Invasive Gastroenterology Unit Director, Dr. Oren Gal, Dr. Aranovich and Dr. Zilbermintz. The surgery was successful, and both the staff and patient were pleased that no abnormal finding was found. She was discharged home in good health.